Medical Management Of Gastroesophageal Reflux Disease Research Articles

Epidemiology, Causes, and Management of Gastro-esophageal Reflux Disease: A Systematic Review.

Our comprehensive systematic review aimed to examine gastroesophageal reflux disease (GERD), a disorder that occurs when stomach contents flow back into the esophagus. It may manifest as either non-erosive reflux disease or erosive esophagitis. The activity depicts the assessment and medical management of GERD and emphasizes the interprofessional team's involvement to enhance care for people with this ailment. Data sources were PubMed/Medline and Embase. Our review investigated English-language articles (from 2014 to 2023) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Overall, there were seven articles. Surveys and analyses of national databases were the most widely used methods (n=7). The search identified 3,730 studies, and seven were eligible for inclusion in the analysis. Further understanding of GERD and treatment protocols may help improve evaluation and management in the future. Millions of individuals worldwide suffer from GERD, a common clinical condition. Patients can be identified by symptoms that are both common and uncommon. For many GERD patients, acid suppression treatment reduces symptoms and avoids clinical complications. Our capacity to recognize and treat disease consequences has improved with the advancement of diagnostic and treatment methods. Here, we go into the etiology and consequences of GERD and offer details on the treatment strategy for this prevalent illness.

Thailand guideline 2020 for medical management of gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is one of the most prevalent and bothersome functional gastrointestinal disorders worldwide, including in Thailand. After a decade of the first Thailand GERD guideline, physician and gastroenterologist encountered substantially increase of patients with GERD. Many of them are complicated case and refractory to standard treatment. Concurrently, the evolution of clinical characteristics as well as the progression of investigations and treatment have developed and changed tremendously. As a member of Association of Southeast Asian Nations, which are developing countries, we considered that the counterbalance between advancement and sufficient economy is essential in taking care of patients with GERD. We gather physicians from university hospitals, as well as internist and general practitioners who served in rural area, to make a consensus in this updated version of GERD guideline focusing in medical management of GERD. This clinical practice guideline was constructed adhering with standard procedure. We categorized the guideline in to four parts including definition, investigation, treatment, and long‐term follow up. We anticipate that this guideline would improve physicians' proficiency and help direct readers to choose investigations and treatments in patients with GERD wisely. Moreover, we wish that this guideline would be applicable in countries with limited resources as well.

Feasibility of resection and plication "RAP" technique for management of medically refractory GERD in patients with altered gastric anatomy.

Background and study aims Gastroesophageal reflux disease (GERD) is common, especially in patients after gastric surgery. Medical management of GERD is ineffective in up to 30 % patients and revisional gastric surgery for management of GERD is associated with higher morbidity. We aimed to assess the safety, feasibility, and efficacy of a novel endoscopic resection and plication (RAP) anti-reflux procedure for management of medically refractory GERD in patients with altered gastric anatomy. Patients and methods The RAP procedure involves endoscopic mucosal resection and full-thickness plication over the right posterior-medial axis extending 15 mm above and 20 to 30 mm below the squamocolumnar junction. Adverse events, technical feasibility, GERD health-related quality-of-life (GERD-HRQL) scores, and medication use were prospectively recorded. Results Twenty consecutive patients with previous gastric surgery underwent RAP between September 2018 and August 2020 with a median follow-up of 5.7 months. The median procedure duration was 66 minutes (IQR 53.8–89.5). RAP was technically successful in 19 patients. One patient developed gastric hemorrhage from suture dehiscence, which was managed endoscopically, and four patients developed esophageal stricture requiring endoscopic dilation. Following the RAP procedure, significant improvement in GERD-HRQL score was observed (mean 26.9, 95 %CI 23.36–30.55, P < 0.01). Fourteen of 19 patients reported > 50 % improvement in GERD-HRQL scores. Sixteen of 18 patients reported reduction in requirement for or cessation of antacid therapy. Conclusions Patients with refractory GERD after gastric surgery have limited therapeutic options. We have demonstrated that the RAP procedure is feasible, safe, and clinically effective at short-term follow-up. It provides a potential alternative to revisional surgery in patients with altered gastric anatomy.

Clinician Knowledge of Societal Guidelines on Management of Gastrointestinal Complications in Esophageal Atresia.

The aim of this study was to assess whether clinicians approached the management of children with esophageal atresia (EA) in accordance with the 2016 European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)/North American Society of Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines on the management of gastrointestinal and nutritional complications in this cohort. We invited expert physicians and surgeons closely involved in the care of children with EA (members of the International network on esophageal atresia [INoEA], ESPGHAN EA working group, French national EA registry, European pediatric surgical association (EUPSA), and European rare disease reference network [ERNICA]) to participate in an anonymous online survey containing 15 multiple choice questions concerning the management of gastrointestinal and nutritional complications in children with EA. Questions were based on the management of gastroesophageal reflux disease (GERD) dysphagia, cyanotic spells, feeding and nutrition, anastamotic strictures, and transition to adult care as detailed in the 2016 guidelines. Median concordance with ESPGHAN/NASPHAN EA Guidelines was 69% (16-100%, SD 16%) across all responders. Areas of greatest concordance were in the fields of surveillance endoscopy and medical management of GERD. Areas for potential educational opportunities include: the differential diagnosis and appropriate investigation of dysphagia and the diagnostic evaluation of extraesophageal symptoms. This survey highlights the importance of improving the understanding and adherence to the EA guidelines amongst clinicians involved in the care of these patients.

The Medical Management of Gastroesophageal Reflux Disease: A Narrative Review.

ObjectiveThe medical management of gastroesophageal reflux disease (GERD) continues to evolve. Our aim was to systematically assess the literature to provide an updated review of the evidence on lifestyle modifications and pharmacological therapy for the management of GERD.BackgroundThe cornerstones of GERD medical management consist of lifestyle modifications and pharmacologic agents. Most recently, evidence has emerged linking anti-reflux pharmacologic therapy to adverse events, such as kidney injury, metabolic bone disease, myocardial infarction, and even dementia, among others.MethodsA systematic search of the databases of PubMed/MEDLINE, Embase, and Cochrane Library was performed for articles on the medical management of GERD between inception and March 1, 2021.ConclusionAlthough pharmacological therapy has been associated with potential adverse events, further research is needed to determine if this association exists. For this reason, lifestyle modifications should be considered first-line, while pharmacologic therapy can be considered in patients in whom lifestyle modifications have proven to be ineffective in controlling their symptoms or cannot institute them. Naturally, extra-esophageal causes for GERD-like symptoms must be considered on suspected high-risk patients and excluded before considering treatment for GERD.

W1078 Should Fundoplication Be Added at the Time of Gastrostomy Placement in Profoundly Handicapped Patients With Dysphagia?

Background: Handicapped patients with advanced neurological impairment and dysphagia require gastrostomy feeding and are associated with gastroesophageal reflux disease (GERD). Concurrent fundoplication is often recommended at the time of gastrostomy placement (GP) in those patients because of avoiding long-term anti-reflux medication or preventing future reflux symptoms. Fundoplication has recently been thrown doubts about its indication in those patients because of unignorable complications and the high incidence of recurrence of GERD. It was aimed in this study to conduct a retrospective review of the outcome of handicapped patients with GP alone. Methods: The subjects consisted of 60 profoundly handicapped patients requiring tube feeding, aged 1 yr to 33 yrs (median 9 yrs), who underwent GP alone. The operative criteria included no or medically controllable reflux symptoms. Operative procedure was laparoscopic in 53 and open in 7. They were divided into two groups based on % esophageal total time pH<4.0 (reflux index:RI) evaluated with preoperative 24-hour esophageal pH monitoring; Group I (GI, n=37): RI<5.0 %, median age 7 yrs (2yrs-33 yrs), Group II (GII, n=23): RI≥5.0 %, median age 11yrs(1yr -21 yrs). Postoperative pH monitoring was performed in 26 GI patients and 20 GII. Follow-up period ranged 2 yrs to 8 yrs(median 4 yrs). Data are expressed as medians and ranges. Results: Postoperative medical management of GERD succeeded in 3 of 4 GI patients and 12 of 13 GII with lansoprazole, famotidine, and a herbal medicine, rikkunshito. A GI patient with chromosomal anomaly required fundoplication after GP because of intractable emesis. A GII with Cockayne Syndrome required gastrojejunal continuous feeding because of emesis and diarrhea. Other patients were successfully nourished with gastrostomy bolus feeding. Respiratory symptoms were ameliorated in a GI patient and 3 GII presumably due to the removal of stimulation by nasogastric tubes. Chronic gastric volvulus was corrected in 4. The postoperative RI increased significantly in GI patients (2.0% [0%-4.8%] vs. 4.1%[0.2%11.9%], P=0.002), whereas decreased significantly in GII (11.8% [5.9%-67.2%] vs. 9.7%[1.0%-68.7%], P=0.048). Conclusions: Reflux symptoms and pathological esophageal acid exposure rarely deteriorate after GP in profoundly handicapped patients with dysphagia. GP alone is a less invasive and effective procedure to improve the quality of life in those patients. Concomitant fundoplication is unnecessary in most of them with adequate medical control of reflux symptoms.

W1079 Effect of Endoscopic Fundoplication With EsophyX Device on Proton Pump Inhibitors Usage in a Single Third Level Italian Care Center

Background: Handicapped patients with advanced neurological impairment and dysphagia require gastrostomy feeding and are associated with gastroesophageal reflux disease (GERD). Concurrent fundoplication is often recommended at the time of gastrostomy placement (GP) in those patients because of avoiding long-term anti-reflux medication or preventing future reflux symptoms. Fundoplication has recently been thrown doubts about its indication in those patients because of unignorable complications and the high incidence of recurrence of GERD. It was aimed in this study to conduct a retrospective review of the outcome of handicapped patients with GP alone. Methods: The subjects consisted of 60 profoundly handicapped patients requiring tube feeding, aged 1 yr to 33 yrs (median 9 yrs), who underwent GP alone. The operative criteria included no or medically controllable reflux symptoms. Operative procedure was laparoscopic in 53 and open in 7. They were divided into two groups based on % esophageal total time pH<4.0 (reflux index:RI) evaluated with preoperative 24-hour esophageal pH monitoring; Group I (GI, n=37): RI<5.0 %, median age 7 yrs (2yrs-33 yrs), Group II (GII, n=23): RI≥5.0 %, median age 11yrs(1yr -21 yrs). Postoperative pH monitoring was performed in 26 GI patients and 20 GII. Follow-up period ranged 2 yrs to 8 yrs(median 4 yrs). Data are expressed as medians and ranges. Results: Postoperative medical management of GERD succeeded in 3 of 4 GI patients and 12 of 13 GII with lansoprazole, famotidine, and a herbal medicine, rikkunshito. A GI patient with chromosomal anomaly required fundoplication after GP because of intractable emesis. A GII with Cockayne Syndrome required gastrojejunal continuous feeding because of emesis and diarrhea. Other patients were successfully nourished with gastrostomy bolus feeding. Respiratory symptoms were ameliorated in a GI patient and 3 GII presumably due to the removal of stimulation by nasogastric tubes. Chronic gastric volvulus was corrected in 4. The postoperative RI increased significantly in GI patients (2.0% [0%-4.8%] vs. 4.1%[0.2%11.9%], P=0.002), whereas decreased significantly in GII (11.8% [5.9%-67.2%] vs. 9.7%[1.0%-68.7%], P=0.048). Conclusions: Reflux symptoms and pathological esophageal acid exposure rarely deteriorate after GP in profoundly handicapped patients with dysphagia. GP alone is a less invasive and effective procedure to improve the quality of life in those patients. Concomitant fundoplication is unnecessary in most of them with adequate medical control of reflux symptoms.

Surgical Approach to Gastroesophageal Reflux Disease: What the Radiologist Needs to Know

Gastroesophageal reflux disease (GERD) is defined as gastroesophageal reflux resulting in symptoms or in injury to the esophageal epithelium. Although the medical management of GERD has improved, an increasing number of laparoscopic antireflux surgical procedures are being performed. Barium studies, endoscopy, manometry, and pH monitoring are all integral components of preoperative evaluation. Barium swallow examination must allow critical evaluation of esophageal peristalsis, the presence and extent of gastroesophageal reflux, and complications including esophagitis, stricture, and Barrett esophagus. It is crucial to identify and characterize hiatal hernia and longitudinal stricture, which can result in a shortened esophagus. In such cases, it becomes necessary for the surgeon to incorporate an esophageal lengthening procedure prior to fundoplication; otherwise, poor surgical outcome is likely. Normal postfundoplication radiographic findings as well as postoperative complications (eg, tight wrap, perforation, abscess, complete or partial dehiscence, recurrent stricture, recurrent hernia, intrathoracic migration of the wrap) must also be recognized and clearly understood by the radiologist. Given the chronic nature and prevalence of symptomatic GERD and the increasing number of patients undergoing surgical intervention, it is imperative that the radiologist understand the pre- and postsurgical evaluation of affected patients.

Therapeutic Approaches to Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a common disorder. It often occurs concurrently with other disorders and can be a concomitant of medications used in the management of pain and other symptoms. Patients with GERD present with a broad spectrum of symptoms ranging from mild intermittent episodes of heart-burn to severe, bleeding esophageal erosions and ulcers. Lifestyle modifications serve as the cornerstone to initial medical therapy. Pharmacological options include antacids, alginic acid, sucralfate, histamine-2 (H2) receptor antagonists, proton pump inhibitors, and prokinetic agents. Relief of mild GERD symptoms can be achieved with antacids, or over-the-counter H2 receptor antagonists. Patients with moderate to severe disease require sustained inhibition of gastric acid secretion to control symptoms, heal the esophagus, and prevent complications. Preventing symptomatic recurrence and maintaining remission increases quality of life and decreases overall costs associated with the disease. This paper reviews the etiology, pathogenesis, clinical presentation, and medical management of GERD. Emphasis is placed on the comparative efficacy and safety of pharmacotherapy and recommendations are made with regard to treatment strategies and the cost-effectiveness of therapeutic regimens.

Gastroesophageal Reflux Disease as a Likely Cause of “Idiopathic” Subglottic Stenosis

The cause of subglottic stenosis (SGS) is unknown for a subgroup of patients in which there is a female predominance. Seven women ranging in age from 39 to 66 years developed symptomatic and progressive SGS. Six of the 7 patients failed to respond to all measures of conservative and radical surgical intervention. After recent thorough evaluation for gastroesophageal reflux disease (GERD) followed by medical management for such, these 6 patients have stabilized and have responded to surgical management. The seventh patient recently presented with SGS, was evaluated and treated for GERD, and has not required any surgical management. This study suggests that GERD laryngitis may be pertinent in the development of SGS. Medical management of GERD thus appears vital to successful treatment of idiopathic SGS.